Initiation of interferon beta-1a at initial diagnosis of multiple sclerosis may
reduce neurological and clinical symptoms of disease progression.

Interferon beta reduces activity in multiple sclerosis, as measured clinically
and by magnetic resonance imaging (MRI). Dr Giancario Comi and colleagues at the
Department of Neuroscience, Scientific Institute The University of Milan, Milan,
Italy, and at 57 medical centers in 14 European countries assessed the effect of
interferon beta-1a on the occurrence of relapses in patients after first
presentation with neurological events, who are at high risk of conversion to
clinically definite multiple sclerosis.

In the trial, 308 eligible patients had had a first episode of neurological
dysfunction suggesting multiple sclerosis within the previous three months and
had strongly suggestive brain MRI findings. Patients were randomly assigned
interferon beta-1a 22 mg, or placebo, subcutaneously once weekly over two years.

Neurological and clinical assessments were carried out every six months and
brain MRI every 12 months. At the end of the trial 278 (90 percent ) of patients
remained. There were 57 patients (85 percent ) of 67 patients who stopped
therapy after conversion to clinically definite multiple sclerosis.

Clinicians found that fewer patients (34 percent) in the interferon groups
developed clinically definite multiple sclerosis in the interferon group than in
the placebo group (45 percent). A period of time at which 30 percent of patients
had converted to clinically definite multiple sclerosis was 569 days in the
interferon group, compared with 252 days in the placebo group.

Dr Comi and colleagues said that while it is not proven, indications "suggests
that early multiple sclerosis is more sensitive to the therapeutic effect of
interferon beta-1a than more advanced disease. The therapeutic benefit on
relapses is supported by the MRI findings, in which both lesion activity and the
accumulation of lesion burden were reduced compared with placebo.

Among the various effects on MRI, we observed that interferon beta-1a also
resulted in a significant increase in the proportion of patients with absence of
any MRI activity over two years."

Injection-site reactions among the patients were common, but they were mostly
mild, and injection-site necrosis was not observed. Good tolerability
contributed to good compliance in the trial, the clinicians concluded.